Class: Non-Opioid Analgesic & Anti-Pyretic
Generic Name: acetaminophen
Prototypes/Brand Name: Tylenol, Panadol
Mechanism: Reduces fever by acting directly on hypothalamic heat-regulating center.
Analgesic mechanism unclear. Not an anti-inflammatory agent
Administration
Indications
Contraindications
• Can be given orally or rectally
• Arthritis and
• Allergy to
• Assess pain prior to and after
rheumatic disorders
acetaminophen.
administration
involving
• Use cautiously with
• Administer with a full glass of water
musculoskeletal pain
impaired hepatic
• Maximum dose over 24-hour period: • Common cold, flu,
function, chronic
o 4000 mg adults,
other viral and
alcoholism,
o 3200 mg geriatric
bacterial infections
pregnancy,
o 2000 mg clients with chronic
with pain and fever
lactation.
alcoholism
Therapeutic Effects:
 Antipyretic: Reduction in fever
 Analgesic: Reduction in pain
Side Effects
• Skin reddening
• Hypersensitivity: Rash, fever
• Hepatotoxicity (liver damage)
• Renal damage
SAFETY: Do not exceed
recommended dose. Report rash,
bleeding, or yellowing of skin. If
overdose, monitor serum levels.
Antidote is acetylcysteine
Nursing Considerations
• Assess history and
physical condition
related to liver and
kidneys
• Avoid using multiple
preparations with
acetaminophen
Class: NSAID & Antiplatelet
Generic Name: acetylsalicylic acid
Prototype/Brand name: aspirin
Mechanism:
Inhibits the synthesis of prostaglandins. Inhibition of platelet aggregation.
Administration
Indications
Contraindications
• Given orally
• Mild to moderate
• Allergy to salicylates,
• Assess pain before and
pain
NSAIDs
after
• Fever
• Conditions that increase risk
• Not for children under 12
• rheumatic fever,
of bleeding, or clotting
• Take with a full glass of
rheumatoid arthritis,
deficiencies.
water and food. Sit
osteoarthritis
• Caution with impaired renal
upright for 15-30 min
• Reduced risk of
• Surgery scheduled within 1
• Do not crush, chew,
recurrent stroke in
wk
break, or open an EC pill.
males.
• Pregnancy & breastfeeding
Swallow whole
• MI prophylaxis
• chewable must be
Do not use in children/ teens
chewed
for chickenpox or flu
• Stop 7 days prior to
symptoms without review for
surgery
Reye’s syndrome.
Therapeutic Effects:
• Treatment of mild pain and fever
• Reduces the risk of heart attack and stroke
Side Effects
• Acute aspirin toxicity:
hemorrhage, seizures,
tetany, CV, renal and
respiratory failure
• Aspirin intolerance:
bronchospasm, rhinitis
• Nausea, hepatotoxicity
• Blood loss
• Hypersensitivity
• Salicylism (Dizzy, tinnitus)
SAFETY: Emergency procedures
if overdose (i.e., Gastric lavage,
activated charcoal, etc.)
Nursing Considerations
• Assess history, allergies,
and physical condition
related to liver, kidneys,
hemostasis, viral infection,
pregnancy, and lactation
• Keep out of the reach of
children
• Report ringing in the ears;
dizziness, confusion;
abdominal pain; rapid or
difficult breathing; nausea,
vomiting, bloody stools.
Classification: Non-Steroidal Anti-Inflammatory Drug (NSAID)
Generic Name (Prototype/Brand Name):
ibuprofen (Motrin, Advil)
ketorolac (Toradol)
celecoxib (Celebrex)
Therapeutic Effects:
• Treatment of mild pain and fever
• Decreases pain and inflammation caused by arthritis
or spondylitis
Mechanism: Anti-inflammatory and analgesic effects without the adverse effects associated with
corticosteroids. Inhibition of prostaglandin synthesis. Blocks cyclooxygenase (COX) 1 and 2.
Administration
Indications
Contraindications
Side Effects
• PO or IV/IM
• Pain and
• Allergy to NSAIDs or salicylate; or
• CNS: headache, dizziness,
(ketorolac)
inflammation
sulfonamides (celecoxib)
fatigue
• Assess pain before
related to arthritis • CV, renal, or liver dysfunction.
• CV: HTN, CVS events, heart
and after
• Mild to moderate
• Peptic ulcer or known GI bleed
failure, edema (Celecoxib)
• Take with food or
pain
• Thrombotic events
• GI: nausea, dyspepsia, GI
milk if upset stomach • Pain from primary • Pregnancy or lactation.
pain, constipation, diarrhea,
• Stay well hydrated
dysmenorrhea
• Hema: bleeding (GI, gums),
• Fever reduction
Drug-drug interactions:
platelet inhibition,
Absorption: GI
• Loop diuretics
• Steven Johnson syndrome
Metabolism: Liver
• Beta-blockers
• Ketorolac: Abnormal taste
Excretion: Kidneys
• Lithium toxicity (ibuprofen)
• anticoagulants
SAFETY: If overdose, implement
• ethanol ingestion
gastric lavage.
Nursing Considerations
• Assess for allergies, S&S of
GI bleed, skin rash, renal
function, Liver function.
• Use drug only as
suggested; avoid overdose.
• Report sore throat, fever,
rash, itching, weight gain,
swelling in ankles or
fingers, changes in vision,
black or tarry stools.
Class: Opioid Analgesic
Generic Name (Prototype/Brand Name):
morphine sulfate (M-ESlon, MS Contin)
hydromorphone (Dilaudid)
fentanyl (Duragesic)
Mechanism: Binds to opioid receptors in the CNS and alters the perception of and
response to painful stimuli while producing generalized CNS depression.
Administration
Indications
Contraindications
• IR and SR oral preparations
• Relief of moderate to • Acute pancreatitis
• IV, SC, IM, rectal, epidural,
severe acute and
• Renal impairment
or transdermal.
chronic pain
• Liver impairment
• Used in all ages.
• Analgesic during
• Respiratory
• Caution in pregnant and
anesthesia
depression
breastfeeding women, liver • Pulmonary edema
• Paralytic ileus
and renal impairment, and
• Cancer pain and pain • Obstructive airway
elderly clients.
at end of life because
disease
• If nausea, take with food
there is no “ceiling
• Increased
and lay quietly
effect,”
intracranial pressure
• Acute alcoholism
Therapeutic Effects:
• Treatment of moderate to severe pain
• Suppression of cough or respiratory distress
Side Effects
• CNS depression (respiratory, CVS,
sedation, N/V, sweating)
respiratory depression
• Sweating, Pruritis
• Potentially Fatal: Respiratory
depression; circulatory failure;
hypotension; deepening coma;
anaphylactic reactions.
SAFETY Assess resp and sedation,
naloxone for reversal. Consider a
bowel regime for risk of constipation.
Nursing Considerations
• Assess for allergies, S&S of
respiratory & CNS
depression, GI obstruction,
head injury etc.
• Do not perform hazardous
activities
• No other CNS depressants.
• Do not cut, crush, or chew
controlled release
• Dilute and administer IV
slowly
Class: Opioid Antagonist
Generic Name: naloxone
Prototype/Brand Name: Narcan
Therapeutic Effects:
Reversal of analgesia and CNS and respiratory depression caused
by opioid agonists.
Mechanism: competes with opioid receptor sites in the brain and, thereby, prevents
binding with receptors or displaces opioids already occupying receptor sites.
Administration
Indications
Contraindications
Side Effects
• Safety and effectiveness
• complete or
• Allergy to narcotic
 CNS: agitation, reversal of analgesia
have not been established
partial
antagonists.
 CV: tachycardia, blood pressure
in children.
reversal of
• Pregnancy,
changes, dysrhythmias, pulmonary
• Caution for pregnant and
opioid effects
lactation.
edema
lactating women
• Narcotic addiction.  Acute narcotic abstinence syndrome
• repeated doses PRN
• CV disease.
• IV onset: 2 mins
SAFETY: If providing naloxone for an
• IM onset: 3-5 mins
overdose consider CPR as needed to
• Metabolism: Liver
support the client.
• Excretion: Kidney (urine)
Nursing Considerations
• Assess for allergies, and S&S of MI
• Conduct baseline pain assessment
• Excessive doses in postop clients
may result in significant reversal
of analgesia and may cause
cardiovascular events
• Provide comfort measures to help
client cope with pain
Class: Adjuvant Analgesic
Generic Name: baclofen
Prototype/Brand Name: APO-Baclofen
Mechanism: inhibits reflexes at the spinal level.
Administration
Indications
• Baclofen is safe for clients
• Muscle symptoms
12 years and older.
(such as spasm, pain,
• Do not take this drug during
and stiffness, caused
pregnancy.
by multiple sclerosis,
• PO and intrathecal routes
spinal cord injuries,
• Excretion: Kidneys
or other spinal cord
disorders).
Therapeutic Effects:
• Inhibition of spasticity and muscle stiffness
• Reduction of pain
Contraindications
• Hypersensitivity.
Active peptic
ulcer disease.
• Caution for use
with renal
impairment.
Side Effects
• Drowsiness, dizziness or lightheadedness, confusion, nausea,
constipation, sedation, and muscle
weakness.
• Potentially Fatal: Respiratory or CV
depression, seizures.
SAFETY WARNING: Abrupt
discontinuation can cause serious
reactions.
Nursing Considerations
• Assess for allergies, and S&S of MI
• Avoid abrupt withdrawal
• Avoid use with alcohol or other
CNS depressants.
• Report frequent or painful
urination, constipation, nausea,
headache, insomnia, or confusion
that persists or is severe.
Class: Adjuvant Analgesic
Generic Name: cyclobenzaprine
Prototype/Brand Name: Flexeril, Novo-Cycloprine
Mechanism: reduces tonic somatic muscle activity at the level of the brainstem.
It is structurally like tricyclic antidepressants. Precise mechanism not known
Administration
Indications
Contraindications
• Use cautiously with
• Used to treat
• Hypersensitivity to
geriatric clients, and those
acute muscle
cyclobenzaprine
who take antidepressants
spasms.
• Acute recovery phase
and other CNS
of MI, arrhythmias,
depressants.
heart block or
• Safety and efficacy in
conduction
clients under 15 years are
disturbances, CHF
not established.
• Hyperthyroidism.
• Caution with urinary
.
retention, glaucoma,
lactation, mild hepatic
impairment
Therapeutic Effects:
• Reduction of pain and muscle spasms
Side Effects
• Antimuscarinic effects,
neurological adverse effects, GI
disorders, orthostatic
hypotension, tachycardia,
hypersensitivity reactions.
• Increased appetite/wt. gain
• Increased sedation with other CNS
depressants
• Serotonin Syndrome
SAFETY: Orthostatic hypotension.
Nursing Considerations
• Assess for allergies, and S&S of
CV disease
• Inform clients about serious
side effects
• Avoid concurrent use with
alcohol or other CNS
depressants.
• Report urinary retention or
difficulty voiding, pale stools,
yellow skin, or eyes.
Class: Antigout
Generic Name: allopurinol
Prototype/Brand Name: Purinol
Therapeutic Effects:
• Prophylaxis or treatment of gout
• Urine alkalinity
Mechanism: blocks production of uric acid by inhibiting the action of xanthine oxidase
Administration
Indications
Contraindications
Side Effects
• Safe for all ages
• Treatment of
• Allergy to
• Hypotension, flushing, hypertension,
• Reduce dose for renal
gouty arthritis
allopurinol, blood
drowsiness, nausea and vomiting,
impairment
and nephropathy
dyscrasias.
diarrhea, hepatitis, renal failure, or a
• drink 2.5 to 3 L/day to
• Treatment of
• Use cautiously with
drug rash with eosinophilia and
decrease the risk of
secondary
liver disease, renal
systemic symptoms (DRESS)
renal stone
hyperuricemia.
failure, lactation,
syndrome or drug hypersensitivity
development.
pregnancy
syndrome.
• Take after meals.
SAFETY: Discontinue drug at first sign of
skin rash
Nursing Considerations
• Assess for allergies, and S&S of
hyperuremia
• Take as directed.
• Reduce alcohol consumption.
• Regular blood tests.
• Alkaline diet and increased fluid prevent kidney stone
• Report unusual bleeding, bruising,
or rash to a health care provider
immediately.